Current trends and future directions in IR procedures

[IRrads10]

What are the current trends and future directions of IR procedures?

For those in IR, what does your typical caseload look like? Has this changed at all in recent years?

Can anyone on the research and design side comment on areas of medicine that IR is trying to design/ refine procedures for?

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[brownmed.vir]

I'm really interested in hearing about people's input on this too. Any thoughts?

 

[IRrads10]

http://circ.ahajournals.org/content/128/Suppl_22/A601.abstract

https://www.advisory.com/research/i...rtnership/the-reading-room/2016/04/ir-wrap-up

Hopefully some will find these articles enlightening!

 

[mcridog3]

The bread and butter:
1. Central venous access (ports, lines)
2. Biopsy/aspiration
3. Infection management (abscess drains etc.)
4. Nephrostomy and PCNL

The bulk of the advanced procedures:
1. Hepatobiliary disease (TIPS, PTC, biliary drainage)
2. Venous disease
- DVT tx
- Filter work
- Venous stenting/reconstruction
- Varicose veins
3. Interventional Oncology - intraarterial (TACE/Y90 etc)
4. Interventional Oncology - ablation (Microwave, RF, Cryo)
5. Trauma/Bleeders

Misc:
1. Uterine Fibroid Embo
2. AVM embolization
3. Splanchnic aneurysm treatment
4. Thoracic duct embolization
5. PE lysis

Center-specific:
1. Dialysis interventions (volume varies from place to place)
2. Pain management / MSK interventions - rare
3. Peripheral arterial disease (volume and complexity vary from place to place)
4. Aortic stenting
5. Carotid stenting
6. Stroke interventions

Up and coming:
1. Bariatric embolization
2. Prostate artery embolization

I'm obviously going to be forgetting a few things. The field is huge and no one person feels comfortable doing everything... You'll find what you like and build a practice around that.

 

[IRrads10]

The bread and butter:
1. Central venous access (ports, lines)
2. Biopsy/aspiration
3. Infection management (abscess drains etc.)
4. Nephrostomy and PCNL

The bulk of the advanced procedures:
1. Hepatobiliary disease (TIPS, PTC, biliary drainage)
2. Venous disease
- DVT tx
- Filter work
- Venous stenting/reconstruction
- Varicose veins
3. Interventional Oncology - intraarterial (TACE/Y90 etc)
4. Interventional Oncology - ablation (Microwave, RF, Cryo)
5. Trauma/Bleeders

Misc:
1. Uterine Fibroid Embo
2. AVM embolization
3. Splanchnic aneurysm treatment
4. Thoracic duct embolization
5. PE lysis

Center-specific:
1. Dialysis interventions (volume varies from place to place)
2. Pain management / MSK interventions - rare
3. Peripheral arterial disease (volume and complexity vary from place to place)
4. Aortic stenting
5. Carotid stenting
6. Stroke interventions

Up and coming:
1. Bariatric embolization
2. Prostate artery embolization

I'm obviously going to be forgetting a few things. The field is huge and no one person feels comfortable doing everything... You'll find what you like and build a practice around that.

Thanks for the insightful reply!

 

[irwarrior]

Much of the hepatobiliary work/ TIPS/BRTO as well as IO for liver directed therapy will be usually done in liver transplant centers and academic centers.

In the community, the common high end things that can be developed are lower extremity PAD interventions (especially for CLI), dialysis interventions as well as venous disease (superficial/varicose veins) and deep venous disease/PE (lysis/stenting/thrombectomy /IVC filters/IVC filter retrievals). Pain and palliative procedures are also fairly common disease and include ESI/rhizotomy/vertebral augmentation procedures, and pleural and peritoneal drains.

Fibroid treatment can be a robust part of your practice but you need to market directly to patients and should make sure you are comfortable with AUB and make sure their symptom severity supports treatment.

With the advent of more comprehensive stroke centers , there is a desire to hire someone with stroke interventional skill set (50 to 100 cerebral angios) and 10 to 20 stroke thrombectomy cases.

IO procedures at this point have limited RCT data outside of hepatocellular cancer. This can change once SIRFLOX, FOXFIRE, FOXFIRE global potentially show increased overall survival if compared to systemic chemo alone. Also, CLOCC trial longer term results are interesting and again may suggest more of a role of IO in standard practice.



Biopsies, gastrostomy tube, abscess drains etc are all fairly common bread and butter procedures as well.

Prostate therapy for BPH will need a potential RCT to TURP or Sham limb with perhaps 3 to 5 year data to expect more broad acceptance (though initial results are promising).

You can grow many aspects of this provided you get robust clinical and technical training and can set up a clinic and are able to manage many of these conditions in a comprehensive fashion. It is also imperative that you educate patients and referring physicians about the scope and breadth of your practice.

So, the opportunities for the motivated individual is certainly present and a growing number of IR training programs to enable one to get this clinical and technical skill set.